Prostate Cancer Treatment Can Be Risky

Feb. 18, 2008 (San Francisco) -- For some men with prostate cancer, the risks of a common treatment may outweigh the benefits, new research suggests.

At issue is androgen deprivation therapy to lower levels of male hormones that can fuel prostate cancer growth. Alternately called hormone treatment or ADT, it's a well-accepted treatment for men with advanced cancer that has spread outside the prostate. ADT can be done by orchiectomy (removal of the testicles) or hormone therapy alone to reduce the production of male hormones; it also may be done in combination with anti-androgens, which block the effect of male hormones.

Androgen deprivation therapy -- often in combination with radiation -- is also a standard of care for men with early cancer that is still confined to the prostate.

But it may not always be the best choice, suggest several new studies presented at the 2008 Genitourinary Cancers Symposium.

One study shows that a one-two punch of radiation plus ADT may actually be harmful for older men with early prostate cancer who suffer from other health problems.

Another study of men with early prostate cancer suggests that compared with those who chose watchful waiting -- close monitoring for signs of tumor growth -- hormone therapy may raise the risk of dying.

Dutch researchers report that for some men, delaying androgen deprivation therapy until they start to get worse -- rather than starting it right after diagnosis -- will not cut the odds of survival. But it may improve their quality of life, they say.

Not all the news about ADT was alarming.

In contrast to previous research, Harvard doctors found no evidence that hormone therapy raises the risk of dying of heart disease.

"Androgen deprivation has a high cure rate for more aggressive tumors," says Eric A. Klein, MD, head of urologic oncology at the Cleveland Clinic. Klein, a spokesman for the American Society of Clinical Oncology, was not involved with the research.

"What hasn't been appreciated is that even short-course hormone therapy can have adverse health consequences. We need to be more judicious about the use of hormone treatment (ADT) in our patients," Klein tells WebMD.